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Staging for Remnant Gastric Cancer: The Metastatic Lymph Node Ratio vs. the UICC 7th Edition System.

 Masatoshi Nakagawa  ;  Yoon Young Choi  ;  Ji Yeong An  ;  Jung Hwa Hong  ;  Jong Won Kim  ;  Hyung-Il Kim  ;  Jae-Ho Cheong  ;  Woo Jin Hyung  ;  Seung Ho Choi  ;  Sung Hoon Noh 
 Annals of Surgical Oncology, Vol.23(13) : 4322-4331, 2016 
Journal Title
 Annals of Surgical Oncology 
Issue Date
BACKGROUND: Unlike primary gastric cancer, a remnant gastric cancer (RGC) staging system has not been established. The retrieved lymph node counts (RLN) in RGC is generally lower than that in primary gastric cancer, so it is unclear whether positive lymph node count reflects the RGC patient's survival. Therefore, the lymph node ratio (LR) may be more useful for RGC staging than the 7th edition UICC classification. METHODS: Patients (n = 191) who underwent gastrectomy with curative intent for RGC participated in this study. LR was classified as LR = 0, 0 < LR ≤ 0.1, 0.1 < LR ≤ 0.4, and 0.4 < LR. Modified TNM staging (mTNM-LR) was established by combining the pT (7th UICC) with LR. The predictive accuracy of LR and mTNM-LR was compared with that of the pN (7th UICC) and TNM (7th UICC), respectively. RESULTS: The mean RLN was 14.4 and that of 128 patients (67 %) was ≤15. Fifty-one patients (27 %) had metastatic lymph nodes. Multivariable analyses revealed that pT (7th UICC) (p < 0.001) and pN (7th UICC) (p = 0.001), but not LR, were independent risk factors for overall survival. The overall c-index (95 % confidence interval) of each staging system was as follows: pN (7th UICC): 0.700 (0.627-0.771); LR: 0.701 (0.627-0.775), TNM (7th UICC): 0.808 (0.761-0.870); mTNM-LR: 0.807 (0.737-0.871). There were no significant differences in the predictive accuracy between pN (7th UICC) and LR, and TNM (7th UICC) and mTNM-LR. CONCLUSIONS: LR was not superior to pN (7th UICC). Thus, the 7th edition UICC classification is a practical and reliable staging system for RGC.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
김종원(Kim, Jong Won)
김형일(Kim, Hyoung Il) ORCID logo https://orcid.org/0000-0002-6134-4523
노성훈(Noh, Sung Hoon) ORCID logo https://orcid.org/0000-0003-4386-6886
정재호(Cheong, Jae Ho) ORCID logo https://orcid.org/0000-0002-1703-1781
최승호(Choi, Seung Ho) ORCID logo https://orcid.org/0000-0002-9872-3594
최윤영(Choi, Yoon Young) ORCID logo https://orcid.org/0000-0002-2179-7851
형우진(Hyung, Woo Jin) ORCID logo https://orcid.org/0000-0002-8593-9214
홍정화(Hong, Jung Hwa)
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